Hypertension drugs benefit bypass patients

Vitamin D plays important antimicrobial role. It is known to help immune response, overcome bacteria encountered in hospitals.

Hospital beds.
(photo credit:Ariel Jerozolimski)

Until now, cardiologists have routinely instructed patients facing coronary
artery bypass graft (CABG) surgery to stop taking blood pressure- reducing
drugs, and not to resume taking them immediately afterwards, as it was thought
that these drugs increased the risk to the patient.

But Prof. Benjamin
Drenger, a senior physician at Hadassah University Medical Center’s department
of anesthesiology and critical care medicine, has just published an article in
the prestigious journal Circulation showing the opposite; on the basis of 4,200
patients who underwent CABG, taking ACE inhibitors actually reduced the risk
associated with this type of surgery.

ACE (angiotensin-converting-enzyme)
inhibitors – originally synthesized from compounds found in viper venom – have
long been used to treat hypertension in patients who were either unresponsive to
more basic medication or had a medical history of cardiac insufficiency and
heart attacks.

But the new research shows that patients that resumed
taking ACE inhibitors immediately after CABG surgery suffered many fewer cardiac
complications.

Those patients who had not received ACE inhibitors just
before and after the surgery suffered from many more complications in the
kidneys, and were at greater risk for heart attacks and coronary insufficiency,
Drenger and colleagues wrote.

“Publication of our research, meant for
cardiologists, heart surgeons and internal medicine specialists, is meant to
change the approach” on ACE inhibitors for bypass surgery patients, he
continued.

It may be that renewal of ACE inhibitors immediately after
surgery will become the policy of choice and that in the long term, “the
recommendations in the article will be included in new clinical directives,” the
Hadassah anesthesiologist said.

VITAMIN D FOR IN-HOSPITAL INFECTIONS

Hospital-acquired (nosocomial) infections are a significant threat around the
world. These infections aren’t brought in by patients but are already present in
hospitals, and spread easily among those already sick. In the US alone, there
are an estimated 100,000 deaths a year from hospital-acquired infections, with
some 1.7 million annual cases causing between $30 billion and $40 billion in
excess healthcare costs.

A paper recently published in the journal
Dermato-Endocrinology suggests that raising vitamin D concentrations among
patients has the potential to greatly reduce the risk of nosocomial
infections.

Patients are often vitamin D-deficient since many diseases
such as cancer, cardiovascular disease and respiratory infections are linked to
low vitamin D concentrations.

Pneumonia is the most likely result,
followed by bacteremias, urinary tract infections, surgical site infections and
sepsis.

Vitamin D plays an important antimicrobial role. It is known to
strengthen people’s innate immune response, thus overcoming the antibiotic
resistance of many bacteria encountered in hospitals.

Even in sunny
Israel, where exposure to the sun produces the vitamin in the skin, a large
percentage of people have been found to be vitamin D deficient because many
cover themselves out of modesty or concern about skin cancer due to overexposure
to ultraviolet rays.

The researchers, headed by infectious disease expert
Dr. Dima Youssef of East Tennessee State University, advocated raising vitamin D
concentrations in patients. Not only does the vitamin reduce the rate of
diseases such as many types of cancer, cardiovascular disease, hip fractures and
respiratory infections, but it would also cut the rate of nosocomial
infections.

PRENATAL COUNSELING

Israeli women typically undergo several
ultrasound scans and other tests during pregnancy. But what does one do if a
problem is suspected in the fetus? A new clinic has now opened at Jerusalem’s
Alyn Hospital, the national pediatric and adolescent rehabilitation center for
children with serious physical disability due to genetic disease, accidents or
other causes. The clinic will advise parents whose fetus is suspected of
suffering from heart defects, spina bifida, skeletal defects, muscular
disorders, cleft palate (which can easily be treated with plastic surgery) and
other problems.

Such parents will be able to consult with hospital
director-general Dr. Maurit Be’eri or Dr. Eliezer Be’eri, the deputy
director-general, a social worker and Rabbi Zvi Porat, who specializes in
matters of medicine and halacha.

Parents who want to have the baby
despite suspected disorders will be told what capabilities the baby will have
despite disabilities and what treatments can be offered. The Alyn director said
she hoped the new clinic would relieve parents’ fears and worries and help them
cope.

ELIMINATING QUEUE FOR CHILDREN

Parents of children in the Bnei Brak
area who need help for urological problems have had to wait for three months or
more to get a consultation with a specialist.

Now, the city’s hospital,
Ma’ayanei Hayeshua, has announced the opening of a pediatric urology clinic that
will eliminate the queue.

It is being run by Dr. Bezalel Sivan, an
Orthodox specialist in the field who did his residency at Schneider Children’s
Medical Center and then his subspecialty at Cinncinnati Children’s Hospital, one
of the leading institutions of its kind in the world. Referrals from the health
funds are accepted. The medical center in the largely ultra-Orthodox city began
primarily as an obstetrical hospital but has expanded to including many other
services and departments.

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